Gender Healthcare Policy Map

FAIR’s Gender Healthcare Policy Map is a resource of aggregated information affecting gender modification interventions for minors in the United States.

FAIR aims to update this resource in a timely manner. If you have additional information or comments, please contact us at [email protected].

As of May 2023, nineteen states have passed laws or regulations that raise the age to 18 for gender modification interventions, strictly regulate the practice, or define it as child abuse: Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Nebraska, Mississippi, Missouri, Montana, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and West Virginia. Legal challenges have been launched against several states.

Other states have passed laws to create "sanctuaries" to shield against outside laws, or passed state level civil rights laws defining gender as a protected class for anti-discrimination laws. At least one city, Kansas City, has declared itself a "sanctuary city".

States that have raised the age to at least 18 for gender modification interventions, strictly regulate the practice, or define it as child abuse.

States that have partially restricted gender modification interventions for minors, have pending legislation, or ongoing investigations.

States that act as "sanctuaries", or have pending "sanctuary" laws, for gender modification interventions for minors.

No laws, regulations, or active bills restricting or creating "sanctuaries" for gender modification interventions for minors.

Last Updated: May 16, 2023

Federal Statutes and Regulations

Section 1557 of the Patient Protection and Affordable Care Act Adds Gender Identity as Protected Category
May 2016

The Affordable Care Act (ACA) passed in 2010. Later, Section 1557 underwent a rulemaking process (with a final rule published in 2016) adding gender identity as a federally mandated protected class, thereby requiring participating entities to provide medical care and insurance coverage. Litigation on this rule has been ongoing.
regulation
Proposed Regulation from the Department of Health and Human Services
August 2022

The Department of Health and Human Services (HHS) issued this proposed rule on Section 1557 of the Affordable Care Act (ACA). This rule reasserts the earlier 2016 effort (which is under litigation), again adding gender identity as a protected category and related medical treatment as covered under federal healthcare programs. Issued on August 4, 2022; currently not finalized.
Proposed Rule
FAIR Issues Letter Opposing the Section 1557 Expansion into Gender Identity
September 2022

During the open comment period for the proposed August 2022 regulation, the Foundation Against Intolerance & Racism submitted a letter expressing concern for healthcare providers’ freedoms of religion, conflict of conscience, and professional medical judgment.

FAIR urges the Department to amend the rule, and acknowledge the debate that exists within the medical community.
Letter
FDA Warning for Puberty Blockers in Children
July 2022

The FDA issued a warning about the risk of pseudotumor cerebri, or brain swelling, when certain puberty blockers are used in children. The FDA reports 6 cases, 5 for the use in precocious puberty and one related to transgender care.
FDA Warning
HB 1276 - United States House of Representatives
March 2023

Proposed law to ban gender modification medical services for minors, extends the medical malpractice window to 30 years after age 18.
Bill
S. Bill- United States Senate
March 2023

Proposed law to ban gender modification medical services for minors, extends the medical malpractice window to 30 years after age 18.

Bill
Transgender Bill of Rights
March 2023

A joint resolution in the House of Representatives and Senate to make gender identity a new protected class under Title VII of Civil Rights Act of 1964.

Resolution

Federal Lawsuits and Decisions

View Circuit Court map to see which states are affected by Circuit Court cases.

Franciscan Alliance Inc. v. Xavier Becerra
August 2022

The 5th Circuit Court of Appeals upheld a permanent injunction prohibiting the Department of Health and Human Services from requiring clinicians to provide services and insurance coverage for gender modification procedures.
Ruling
Eknes-Tucker et al v. Governor of the State of Alabama
August 2022

Case litigating Alabama’s Vulnerable Child Protection and Compassion Act that was partially blocked and appealed to the 11th Circuit Court of Appeals. Oral arguments occurred on November 18, 2022.

FInal ruling is pending.
Lawsuit
The Religious Sisters of Mercy v. Xavier Becerra
December 2022

The 8th Circuit Court of Appeals upheld The Catholic Benefits Association’s right to abstain from providing transgender healthcare services that are in conflict with their religious beliefs.
Ruling

Alabama

Vulnerable Child Compassion and Protection Act
May 2022

The legislature passed this law making it a felony—punishable with up to 10 years in prison or a fine up to $15,000—to provide medical care to minors altering or "affirming" their gender, or for school personnel to hide information from parents.

Lawsuit then filed by the ACLU challenging the law in May 2022.
Law
Eknes-Tucker et al v. Governor of the State of Alabama
May 2022

In this case, a family, backed by the ACLU, sued the State of Alabama in May 2022 in order to challenge the Vulnerable Child Compassion and Protection Act.

The court partially upheld the law, allowing hormones for minors while maintaining the ban on surgery. It also upheld the law’s ban on hiding information from parents.

Appealed in Aug 2022 to the 11th Circuit Court of Appeals.
Lawsuit
WPATH order
March 2023

U.S. District Judge ruled in favor of the State that WPATH must provide their internal background data that forms their treatment guidelines for gender dysphoric minors.
Court Order

Alaska

This state has no active bills restricting treatments or creating enhanced protections.

Arizona

Senate Bill 1138
March 2022

Law banning gender reassignment surgery for minors under 18 years old. Law takes effect March 31, 2023.

Signed by Arizona Governor Doug Doucy on March 30, 2022.
Law

Arkansas

SB 199: Protecting Minors from Medical Malpractice Act 2023
Law extending malpractice liability for medical professionals engaged in gender change treatments for minors.

The law goes into effect summer 2023.
Law
Save Adolescents From Experimentation Act (SAFE)
Act 626 of 2021 - Law passed prohibiting physicians from providing “gender transition” treatments such as hormones, puberty blockers, and surgeries to minors under 18 years old.

The ACLU challenged this law in 2021. The law is currently blocked from enforcement due to an injunction and ongoing litigation.
Law
Brandt et al v. Rutledge et al
August 2022

Families backed by the ACLU sued the State of Arkansas in Federal Court in May of 2021 to block the enactment of the SAFE ACT law.

The Federal court granted a preliminary injunction blocking enforcement of the law in July 2021, which was upheld by the 8th Circuit Court of Appeals in August 2022.

A trial on the merits of the law concluded in December 2022 in the US District Court for the Eastern District of Arkansas. The final decision is pending.
Lawsuit

California

SB107 - Gender-Change Health Care Law
October 2022

Prohibits health care providers, law enforcement and courts in California from aiding in another state’s investigation related to a minor receiving gender change treatments in California.
Law

Colorado

SB23-188
April 2023

Governor Polis signed a bill giving legal protections to clinicians and minors receiving gender change services, including subpoena protection from another state, and prohibiting insurance denials or cancellations. Exemptions for sincerely held religious beliefs.
Law

Connecticut

This state has no active bills restricting treatments or creating enhanced protections.

Delaware

This state has no active bills restricting treatments or creating enhanced protections.

Florida

Medicaid Coverage Determination
June 2022

The Florida Medical Board determined that gender change treatments for minors is experimental, and therefore not eligible for Medicaid coverage.

Several lawsuits have been filed against Florida's Medicaid program.

Some gender medicine clinicians filed a rebuttal to the report.

Regulation
Medical Board Ruling
February 2023

Florida’s Board of Medicine and Osteopathic Board of Medicine finalized a rule in Feb 2023 determining that gender change treatments for minors are illegal for licensed physicians in Florida. Minors being treated with hormones prior to the effective date may continue using the medications. The Medical Board is being sued.

Rule effective March 16 2023.

Regulation
CS/SB254
May 2023

Bill allowing the State to take custody of a minor threatened with or receiving gender modification medications or procedures, prohibiting minors from receiving or using State funds for sex change treatments, clinician licensure loss, and creating civil penalties with a 20 year window. Substituted for companion House bill CS/CS/HB 1421.

Signed into law May 17th, 2023.

Lawsuit filed on May 17th asking for an Emergency Order to block the law.

Law
CS/SB 1580: Protections of Medical Conscience
May 2023

Law allowing health care clinicians and insurers to opt out of providing certain treatments based on their conscience based beliefs, such as religious beliefs.

Law

Georgia

SB140
March 2023

This law bans the use of hormones and surgery for gender change in minors. Clinicians are subject to Medical Board administrative action for violations. Exemptions include minors who started hormones prior to July 1, 2023 will be allowed to continue use.
Law

Hawaii

HB891
April 2023

A bill prohibiting gender change surgery for minors and establishing the procedure as a Class A felony.
Bill

Idaho

House Bill 71
April 2023

A law that makes it illegal for clinicians to use hormone medications and surgeries for gender change treatments of minors.
Law

Illinois

HB4664 - Reproductive and Gender Affirming Health Care Bill
Jan. 2023

Law shielding gender change patients and treatment providers from legal action initiated outside of Illinois, as well as action that includes parties both within and outside of Illinois, and requiring gender-change health care medications to be covered by insurers at no cost to the consumer.

Gov. Pritzker press release: https://www.illinois.gov/news/press-release.25906.html

Law

Indiana

SB 480
April 2023

Prohibits hormone medications and surgical services for gender modification of minors, including aiding or abetting such services. The malpractice window extends until the patient is age 28. Hormone prescriptions will be discontinued on January 1, 2024.
Law
HB 1118
Prohibits medical and mental health clinicians in healthcare facilities or schools from engaging in interventions to alter a minor’s biological sex. Knowledge of such activities requires mandatory reporting to child services or police with provision for immunity. Clinicians may face misdemeanor and felony charges as well as potential disciplinary action against their license.
Bill

Iowa

SF 538
March 2023

Bans the use of medications and procedures for gender modification treatments of minors.
Law

Kansas

SB 12
January 2023

A bill to criminalize gender modification treatments for minors, including hormones and surgeries, and providing grounds to classify such interventions as unprofessional for medical licensees.
Bill
SB 233
April 2023

Bill passed creating civil penalties and license removal for a physician who performs gender modification treatments and services for minors.Vetoed by governor.

Bill (Vetoed)

Kentucky

Senate Bill 150
March 2023

A law making gender modification medications and procedures illegal for minors. If a clinician violates the law, they are subject to potential loss of medical license, with a malpractice window going up to a patient age of 30 years old.
Law

Louisiana

HB 648 (Stop Harming Our Kids Act)
April 2023

A bill advancing to make gender modification medications and procedures for minors illegal. Includes malpractice window up to age 40, and sunset for hormonal prescriptions until Dec. 31, 2023. Clinician licenses may be revoked for 2 years. The bill passed the House on May 16th, 2023.

Bill

Maine

LD 1735
April 2023

A bill advancing to prevent legal action from an outside state to be enforced in Maine related to sex modification treatments for minors. Tabled 5/17/23.

Bill

Maryland

SB 460 (Trans Health Equality Act)
May 2023

A law requiring Maryland Medicaid to cover gender modification treatments.

Law

Massachusetts

Chapter 127
July 2022

Emergency law passed making sex modification treatments at any age a “legally-protected health care activity” and blocks actions from other states’ laws in this area.
law

Michigan

SB 4
March 2023

Law passed adding gender identity and expression as protected classes under Michigan’s state level civil rights law.

Law

Minnesota

Executive Order
23-03
March 2023

Reinforces gender modification treatments as “medically necessary” and covered by insurance, empowers agencies to investigate “unfair” practices, requires no assistance from state agencies for outside state actions, protects against extradition, and the Department of Health must submit a comprehensive report by Dec. 31, 2023 about the safety and efficacy of these treatments.
Executive Order
HF 146
April 2023

A “sanctuary bill” for transgender minors and clinicians involved in gender modification treatments by protecting them from legal charges in another state related to prohibitions.

Signed into law April 24th, 2023.
Law

Mississippi

HB 1125 Regulate Experimental Adolescent Procedures (REAP) Act
February 2023

Prohibits gender modification medications and procedures for minors, including insurance coverage to pay for such services. Health care professionals are subject to licensure removal if they break the law.
Law

Missouri

Attorney General Investigation
February 2023

Missouri Attorney General Andrew Bailey launched a multiagency investigation into the Pediatric Transgender Center at St. Louis Children’s Hospital to evaluate alleged patient harm, violations of professional conduct by licensed practitioners, and billing fraud. The investigation was triggered by a whistleblower at the Center.
Investigation
Attorney General Regulation
April 2023

Attorney General Andrew Bailey creates specific regulations outlining practice safeguards for gender dysphoric minors, including specific informed consent documenting experimental nature of the treatments, and requiring mandatory therapy for 18 months prior to starting medications or receiving surgery. Rule effective April 27, 2023 to Feb 6, 2024. The ACLU won a temporary restraining order granted through May 15th, 2023.

An injunction was filed in State Circuit Court by the ACLU and others to block the regulation. Hearing set for May 11th, 2023.
Regulation
SB 49
April 2023

A bill banning gender modification medications and procedures for minors. Prescriptions written prior to Aug 28, 2023 may be refilled through Aug. 28, 2027. Prohibits Medicaid funds for gender modification, and bans related surgeries for inmates. Passed May 10th, and awaiting the Governor's signature.
Bill
Emergency Resolution No. 230385
May 2023

The City Council of Kansas City passed an Emergency Resolution to designate the city as a sanctuary for patients seeking or receiving gender modification treatments, and the clinicians providing such treatments.

Resolution

Montana

Senate Bill 99
April 2023

A law making it illegal to prescribe medication or perform gender modification surgery for minors.
LAW

Nebraska

LB 574 - Let Them Grow Act
January 2023

A bill passed to prohibit gender modification treatments for minors under age 19 and allow damages up to 2 years. Signed by Governor May 22, 2023.

Law

Nevada

SB302
April 2023

Bill passed the Nevada Senate creating certain protections for clinicians’ licenses against sanction, and subpoena protections from other states' legal actions for patients and clinicians involved in gender modification treatments for minors. No further actions taken.

Bill

New Hampshire

HB 417
March 2023

A bill advancing to categorize gender modification treatments for minors as child abuse under The Child Protection Act, and therefore subject to mandatory reporting and investigation.

Bill

New Jersey

S3076
January 2023

A bill introduced to prohibit gender modification interventions for minors.

Bill

New Mexico

HB 7
March 2023

Law passed designating medical treatments for gender modification interventions as a civil right protected against discrimination. Each violation of discriminatory action is a $5,000 fine.
Law

New York

Division of Human Rights - Guidance Document
New York's Division of Human Rights has published a document called "Guidance on Protections from Gender Identity Discrimination" under New York State's "Gender Expression Non-Discrimination Act" (GENDA) law. Issued on January 29, 2020.
Guidance

North Carolina

HB 43
February 2023

A bill advancing in the House to prohibit hormones and surgeries for gender modification for minors. Provisions to revoke a physician's license and charge civil penalties for violations.

Bill
SB 560
April 2023

A bill advancing in the Senate to outline criteria for the legal practice of gender dysphoria treatment and gender modification therapies, including psychological treatments, medications, and surgeries.

Provisions include: no aspect of care may be completed over telehealth platforms, a prewritten consent form outlining specific risks must be signed, two physicians from different institutions must complete an evaluation, and clinicians are subject to civil penalties 15 years after treatments.
Bill
HB 808
April 2023

A bill advancing in the house to raise the age of gender modification surgery to 18 years of age and older. Passed the House and advancing in Senate (S639) as of May 3rd.

Bill

North Dakota

HB1254
April 2023

A law prohibiting gender modification medications and surgical procedures for minors. Signed by the Governor on April 19th, 2023.

Law

Ohio

Save Adolescents from Experimentation Act (SAFE)- HB 68
February 2023

A bill prohibiting medical and surgical interventions for gender modification of minors.

Bill

Oklahoma

Senate Bill 3XX
October 3, 2022

Governor Kevin Stitt signed SB 3XX which blocks funding to prevent gender modification interventions for minors at Oklahoma Children’s Hospital at OU Health.
Law
Senate Bill 613
A law prohibiting gender modification medications and procedures for minors. Licensed healthcare practitioners will be subject to Medical Board investigation, civil and criminal penalties.
Law

Oregon

Senate Joint Resolution 33
April 2023

Resolution to create a ballot initiative for the November 2024 election to add gender identity to Oregon’s State’s Constitution as a protected class against discrimination.
Resolution
HB 2002
May 2023

Currently in Oregon, anyone age 15 and older can seek gender modification interventions without parental consent or notification. An amendment removed a provision that required State health insurance to cover some services for detransitioners, and "all medically necessary gender-related services that are prescribed in alignment with accepted standards of care."
Bill

Pennsylvania

HB138
March 2023

A bill advancing to extend the malpractice window for 30 years from age 18 yo to bring lawsuits against clinicians involved in a minor’s gender modification interventions.
Bill

Rhode Island

SB 958
May 2023

A bill advancing to prohibit gender modification interventions for minors, discipline for health care clinicians involved in such interventions, a thirty (30) year statute of limitation, right to a civil action for damages.

Bill

South Carolina

S. 627
March 2023

A bill prohibiting gender modification medication and procedures for minors or public financing for such medical interventions.
Resolution

South Dakota

House Bill 1080
February 2023

Bans hormones and medical procedures to modify the gender of a minor. Medical professionals are subject to having their license revoked.

Law

Tennessee

General Assembly Bills HB0001/SB0001
March 2023

Law prohibiting gender modification medications or procedures for minors.

Law

Texas

Attorney General Opinion
February 2022

Opinion No. KP-040 - Attorney General Ken Paxton's advisory opinion in Feb 2022 to Texas legislature to include gender modification interventions under the legal definition of child abuse in Texas.

AG Opinion
Letter from Governor Abbott
February 2022

Gov. Greg Abbott sent a Letter to the Department of Family and Protective Services (DFPS) informing them that child gender modification activities fall under rules of mandatory reporting for child abuse to the State.

Letter
Doe vs. Abbott
March 2022

Doe family sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families.In March 2022, the 3rd Circut Court in Texas blocked the order, and in May 2022, the Texas Supreme Court upheld the lower court’s ruling to block the State from investigating families.
Lawsuit
Pflag vs. Abbott
April 2022

Pflag and several families sued Gov. Abbott, DFPS Commissioner, and DFPS over the rule to categorize medical treatments for youth gender dysphoria as child abuse and to investigate families. The case is currently on appeal in the Third Circuit Court of Texas.
Lawsuit
HB 3502
April 2023

A bill advancing in the House to require insurance companies to pay for medical services related to complications and adverse effects from medical gender modification or detransition, including for minors.

Bill
Inves­ti­ga­tion into Dell Children’s Med­ical Cen­ter
May 2023

Attorney General Paxton announced an investigation into the Dell Children’s Medical Center to uncover whether gender modification procedures were unlawfully performed on minor children.
Investigation
SB 1029
May 2023

A bill prohibiting government funds for gender modification treatments, requiring insurance companies to pay for all costs for care, medications, follow-ups, complications, and reversals for life, and clinicians involved to be liable for the life of the patient.
Bill
SB 14
May 2023

Bill raising the age of gender modification treatments to 18 years of age. Passed House and Senate. Sent to the Governor May 19th, 2023.

Bill

Utah

S.B. 16 Transgender Medical Treatments and Procedures Amendments
January 2023

Bans medical service to modify the gender of a minor with gender dysphoria.

Law

Vermont

H. 89
May 2023

A law defining gender modification interventions for minors as a legally protected medical service, and prohibits legal action from another state against persons involved in such interventions.

Law
S. 37
May 2023

A law prohibiting licensing board disciplinary action for clinicians involved in gender modification interventions, requiring Vermont’s public institutions of higher education to adopt gender modification interventions, prohibits a medical malpractice insurer from adjusting a health care clinician’s risk classification or premium charges, and requires a health insurance plan covers gender modification services.
Law

Virginia

Three healthcare related bills restricting gender modification interventions for minors were defeated: SB 791SB 960, and SB 1203. There are no “sanctuary” bills pending.

Washington

Senate Bill 5599
May 2023

A bill advancing to allow licensed shelters to contact the Department of Children, Youth and Families (DCYF), rather than parents or legal guardians, when a minor presents to a shelter and is seeking gender modification interventions.

Bill

West Virginia

HB 2007
March 2023

A law prohibiting gender modification medications or surgical procedures for minors. Effective January 1st, 2024.

Law

Wisconsin

This state has no active bills restricting treatments or creating enhanced protections.

Wyoming

Two healthcare related bills restricting gender modification interventions for minors were defeated: SF 144 and SF 111. No “sanctuary” bills introduced.

International Reference

Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.

 

Finland

Sweden

Norway

United Kingdom

Year & Authority

 

July 2020 Council for Choices in Health Care

December 2022 National Board of Health and Welfare 

March 2023 Norwegian Healthcare Investigative Board

Judicial review in 2020

NICE reviews of cross-sex hormones and puberty blockers, March 2021

Cass Interim Report Feb. 2022

NHS Update May 2023

General Guideline 

First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.

Report

 

Summary of National Guidelines for Children and Adolescence with Gender Dysphoria

Link

Norwegian Healthcare Investigation Board (Ukom) Report 

NHS Update May 2023

* Establishes regional hubs affiliated with children’s hospitals

*Research oversight Board

*Determining standards for data collection and  longitudinal tracking

Social Transition

 Not specified

 Not specified

 Not specified

“Not a neutral act”

Puberty blockers

 Not recommended

Risks outweigh benefits. Use only in research setting

“Experimental”

On hold since late 2020

Cross-Sex hormones

Only if early childhood onset and no mental health issues which could interfere with the gender dysphoria diagnosis

Risks outweigh benefits. Use only in research setting

“Experimental”

16+

Mastectomy

18+

18+

“Experimental”

 Not specified

Genital surgery

18+

 18+

“Experimental”

 Not specified

Notes

Blockers and hormone allowed in rare circumstances but “no decisions should be made that can permanently alter a minor’s mental and physical development.”

The NBHW states “Risks outweigh benefits at a group level”.

Non-binding report. Finland officially follows WPATH SOC 8.

Closed Tavistock late 2022, “not a safe place for children”

 

 

 

Netherlands

Spain

Australia

WPATH 8.0

Year & Authority

 

Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria

Feb 2023 passed national Trans Law

2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH

2022. Standards of Care 8.0

General Guideline 

No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support

Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way

Children can change legal sex from age 12 w/o medical attestation

Largely followed WPATH 7.0

Compared to version 7, removed minimum ages for blockers, hormones, and surgery

Social Transition

Part of protocol

Supported at any age

Endorsed at any age

No minimum age

Puberty blockers

Part of protocol

Not specified

“reversible” No minimum age; begun at Tanner Stage 2 

No minimum age

Cross-Sex hormones

Part of protocol

Not specified

No minimum age

No minimum age

Mastectomy

Part of protocol

Not specified

Probably ok at 16

No minimum age

Genital surgery

Part of protocol

12+

Best deferred to adulthood

No minimum age

Notes

 ——–

Bans counseling which tries to halt or reverse transition process, even at request of patient

Australia’s most populous state, NSW, is funding expansion of medical transition services

 ———-

 

 

Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.” 

France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.” 

 

New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.” 

For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.

Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.

 

Finland

Sweden

Norway

United Kingdom

Year & Authority

 

July 2020 Council for Choices in Health Care

December 2022 National Board of Health and Welfare 

March 2023 Norwegian Healthcare Investigative Board

Judicial review in 2020

NICE reviews of cross-sex hormones and puberty blockers, March 2021

Cass Interim Report Feb. 2022

General Guideline 

First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.

Report

 

Summary of National Guidelines for Children and Adolescence with Gender Dysphoria

Link

Norwegian Healthcare Investigation Board (Ukom) Report 

Standards changing as the Cass Review continues its work. Has challenged widespread use of ‘Dutch Protocol’

Social Transition

 Not specified

 Not specified

 Not specified

“Not a neutral act”

Puberty blockers

 Not specified

Risks outweigh benefits. Use only in research setting

“Experimental”

On hold since late 2020

Cross-Sex hormones

Only if early childhood onset and no co-occurring psych diagnoses

Risks outweigh benefits. Use only in research setting

“Experimental”

16+

Mastectomy

18+

 Not specified

“Experimental”

 Not specified

Genital surgery

18+

 Not specified

“Experimental”

 Not specified

Notes

Blockers and hormone allowed in rare circumstances

 ———

Non-binding report. Finland officially follows WPATH SOC 8.

Closed Tavistock late 2022, “not a safe place for children”

 

 

 

Netherlands

Spain

Australia

WPATH 8.0

Year & Authority

 

Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria

Feb 2023 passed national Trans Law

2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH

2022. Standards of Care 8.0

General Guideline 

No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support

Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way

Children can change legal sex from age 12 w/o medical attestation

Largely followed WPATH 7.0

Compared to version 7, removed minimum ages for blockers, hormones, and surgery

Social Transition

Part of protocol

Supported at any age

Endorsed at any age

No minimum age

Puberty blockers

Part of protocol

Not specified

“reversible” No minimum age; begun at Tanner Stage 2 

No minimum age

Cross-Sex hormones

Part of protocol

Not specified

No minimum age

No minimum age

Mastectomy

Part of protocol

Not specified

Probably ok at 16

No minimum age

Genital surgery

Part of protocol

12+

Best deferred to adulthood

No minimum age

Notes

 ——–

Bans counseling which tries to halt or reverse transition process, even at request of patient

Australia’s most populous state, NSW, is funding expansion of medical transition services

 ———-

 

 

Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.” 

France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.” 

 

New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.” 

For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.

Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.

 

Finland

Sweden

Norway

United Kingdom

Year & Authority

 

July 2020 Council for Choices in Health Care

December 2022 National Board of Health and Welfare 

March 2023 Norwegian Healthcare Investigative Board

Judicial review in 2020

NICE reviews of cross-sex hormones and puberty blockers, March 2021

Cass Interim Report Feb. 2022

General Guideline 

First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.

Report

 

Summary of National Guidelines for Children and Adolescence with Gender Dysphoria

Link

Norwegian Healthcare Investigation Board (Ukom) Report 

Standards changing as the Cass Review continues its work. Has challenged widespread use of ‘Dutch Protocol’

Social Transition

 Not specified

 Not specified

 Not specified

“Not a neutral act”

Puberty blockers

 Not specified

Risks outweigh benefits. Use only in research setting

“Experimental”

On hold since late 2020

Cross-Sex hormones

Only if early childhood onset and no co-occurring psych diagnoses

Risks outweigh benefits. Use only in research setting

“Experimental”

16+

Mastectomy

18+

 Not specified

“Experimental”

 Not specified

Genital surgery

18+

 Not specified

“Experimental”

 Not specified

Notes

Blockers and hormone allowed in rare circumstances

The NBHW states “Risks outweigh benefits at a group level”

Non-binding report. Finland officially follows WPATH SOC 8.

Closed Tavistock late 2022, “not a safe place for children”

 

 

 

Netherlands

Spain

Australia

WPATH 8.0

Year & Authority

 

Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria

Feb 2023 passed national Trans Law

2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH

2022. Standards of Care 8.0

General Guideline 

No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support

Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way

Children can change legal sex from age 12 w/o medical attestation

Largely followed WPATH 7.0

Compared to version 7, removed minimum ages for blockers, hormones, and surgery

Social Transition

Part of protocol

Supported at any age

Endorsed at any age

No minimum age

Puberty blockers

Part of protocol

Not specified

“reversible” No minimum age; begun at Tanner Stage 2 

No minimum age

Cross-Sex hormones

Part of protocol

Not specified

No minimum age

No minimum age

Mastectomy

Part of protocol

Not specified

Probably ok at 16

No minimum age

Genital surgery

Part of protocol

12+

Best deferred to adulthood

No minimum age

Notes

 ——–

Bans counseling which tries to halt or reverse transition process, even at request of patient

Australia’s most populous state, NSW, is funding expansion of medical transition services

 ———-

 

 

Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.” 

France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.” 

 

New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.” 

For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.

Given the number of countries that have some policy or practice about youth gender transition care, this table is incomplete. We have emphasized larger developed countries where current practice is well-defined. For comparison we show recommendations of the latest version of ‘Standards of Care’ from WPATH, the World Professional Association for Transgender Health. Readers with more up-to-date information are encouraged to help us update the table.

 

Finland

Sweden

Norway

United Kingdom

Year & Authority

 

July 2020 Council for Choices in Health Care

December 2022 National Board of Health and Welfare 

March 2023 Norwegian Healthcare Investigative Board

Judicial review in 2020

NICE reviews of cross-sex hormones and puberty blockers, March 2021

Cass Interim Report Feb. 2022

General Guideline 

First line treatment should be psychosocial support, gender-explorative therapy, treatment of comorbid conditions.

Report

 

Summary of National Guidelines for Children and Adolescence with Gender Dysphoria

Link

Norwegian Healthcare Investigation Board (Ukom) Report 

Standards changing as the Cass Review continues its work. Has challenged widespread use of ‘Dutch Protocol’

Social Transition

 Not specified

 Not specified

 Not specified

“Not a neutral act”

Puberty blockers

 Not specified

Risks outweigh benefits. Use only in research setting

“Experimental”

On hold since late 2020

Cross-Sex hormones

Only if early childhood onset and no mental health issues which could interfere with the Gender Dysphoria diagnosis.

Risks outweigh benefits. Use only in research setting

“Experimental”

16+

Mastectomy

18+

 Not specified

“Experimental”

 Not specified

Genital surgery

18+

 Not specified

“Experimental”

 Not specified

Notes

Blockers and hormone allowed in rare circumstances

 ———

Non-binding report. Finland officially follows WPATH SOC 8.

Closed Tavistock late 2022, “not a safe place for children”

 

 

 

Netherlands

Spain

Australia

WPATH 8.0

Year & Authority

 

Original home of the ‘Dutch protocol,’ but clinics are loosening eligibility criteria

Feb 2023 passed national Trans Law

2020. Royal Children’s Hospital, Melbourne, Standards of Care, v 1.3 Endorsed by AusPATH

2022. Standards of Care 8.0

General Guideline 

No official guideline. Original protocol evolving: rising case load, switch to predominance of natal girls, later referrals, less extensive psychological support

Bill broadly addresses societal aspects of LGBTQ integration, and deals with youth gender care only in a limited way

Children can change legal sex from age 12 w/o medical attestation

Largely followed WPATH 7.0

Compared to version 7, removed minimum ages for blockers, hormones, and surgery

Social Transition

Part of protocol

Supported at any age

Endorsed at any age

No minimum age

Puberty blockers

Part of protocol

Not specified

“reversible” No minimum age; begun at Tanner Stage 2 

No minimum age

Cross-Sex hormones

Part of protocol

Not specified

No minimum age

No minimum age

Mastectomy

Part of protocol

Not specified

Probably ok at 16

No minimum age

Genital surgery

Part of protocol

12+

Best deferred to adulthood

No minimum age

Notes

 ——–

Bans counseling which tries to halt or reverse transition process, even at request of patient

Australia’s most populous state, NSW, is funding expansion of medical transition services

 ———-

 

 

Canada’s policies are generally supportive of the Dutch Protocol, but each province has its own health authority and delivery system. For instance, the British Columbia Provincial Health Services Authority follows WPATH standards closely, and facilitates transition for people of all ages through “Trans Care BC.” 

France does not have an official national policy. However in February 2022 the French National Academy of Medicine released an opinion noting an ‘epidemic-like phenomenon’ across the developed world,’ opining that “a great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.” 

 

New Zealand shares many medical guidelines and specialty societies with Australia, including the Royal Australian and New Zealand College of Psychiatrists, which has tried to take a mediating position, and in 2021 affirmed (against the ‘informed-consent’ model) the need for careful psychiatric evaluation and support of gender-conflicted youth. In September 2022, the New Zealand Ministry of Health, recognizing trends in Europe, removed its support of puberty blockers as “a safe and fully reversible medicine” and simply described blockers as “a medicine that can be used to halt the progress of potentially unwanted puberty-related physical changes.” 

For more detailed information on several countries, see this summary maintained by French autism advocate Magali Pignard.